HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kosloske, A. M. Articles by Cartwright, K. C. Search for Related Content PubMed PubMed Citation Articles by Kosloske, A. M. Articles by Cartwright, K. C.

The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 166-170, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

The controversial role of decortication in the management of pediatric empyema

AM Kosloske and KC Cartwright
Department of Surgery, University of New Mexico Hospital, Albuquerque 87106.

Open surgical procedures for pleural empyema remain controversial in children. The pediatric literature generally recommends a prolonged trial of antibiotics and closed tube thoracostomy drainage. We report a favorable experience with a selective approach to open drainage in 22 children, many of whom had an empyema already organizing at admission. Open drainage was considered in children whose conditions failed to improve after 3 to 5 days of therapy with antibiotics and closed drainage. The method of drainage was selected according to the pathologic phase of the empyema: five children with fibrinopurulent empyema were successfully managed by limited decortication, and 17 with organizing empyema received decortication. Clinical improvement was usually dramatic; most of the children became afebrile by postoperative day 3 and were discharged by postoperative day 10. There were no deaths. Three children (14%) had complications of postoperative air leak or infection. Streptococcus pneumoniae (5) and Hemophilus influenzae (3) were the most common single pathogens. The presence of anaerobic bacteria in 8 of 22 children (36%) was associated with rapid organization of the empyema and the need for decortication. Decortication procedures have a low risk and are effective in children with empyema. They should be considered as definitive therapy, rather than as a last resort.

This article has been cited by other articles:

				J. R. Avansino, B. Goldman, R. S. Sawin, and D. R. Flum Primary Operative Versus Nonoperative Therapy for Pediatric Empyema: A Meta-analysis Pediatrics, June 1, 2005; 115(6): 1652 - 1659. [Abstract] [Full Text] [PDF]

				A K Baranwal, M Singh, R K Marwaha, and L Kumar Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia Arch. Dis. Child., November 1, 2003; 88(11): 1009 - 1014. [Abstract] [Full Text] [PDF]

				A Jaffe and G Cohen Thoracic empyema Arch. Dis. Child., October 1, 2003; 88(10): 839 - 841. [Full Text] [PDF]

				A. H. Meier, B. Smith, A. Raghavan, R. L. Moss, M. Harrison, and E. Skarsgard Rational Treatment of Empyema in Children Arch Surg, August 1, 2000; 135(8): 907 - 912. [Abstract] [Full Text] [PDF]

				H. Grewal, R. J. Jackson, C. W. Wagner, and S. D. Smith Early Video-assisted Thoracic Surgery in the Management of Empyema Pediatrics, May 1, 1999; 103(5): e63 - e63. [Abstract] [Full Text] [PDF]

				T. Q. Tan, E. O. Mason Jr, W. J. Barson, E. R. Wald, G. E. Schutze, J. S. Bradley, M. Arditi, L. B. Givner, R. Yogev, K. S. Kim, et al. Clinical Characteristics and Outcome of Children With Pneumonia Attributable to Penicillin-susceptible and Penicillin-nonsusceptible Streptococcus pneumoniae Pediatrics, December 1, 1998; 102(6): 1369 - 1375. [Abstract] [Full Text] [PDF]